Incidence of Ultrathin Descemet Stripping Endothelial Keratoplasty Corneal Graft Rejection following Steroid Discontinuation

• Published in: Current eye research 2021-07, Vol.46 (7), p.930-935
• Main Authors: Walter, Keith, Hartel, Jennifer, Hess, Justin P., Joubert, Eloise, Lee, Roland Y.
• Format: Article
• Language: English
• Subjects: Aged; cornea; corneal graft rejection; Descemet Stripping Endothelial Keratoplasty; dystrophy; Female; Fuchs' Endothelial Dystrophy - surgery; Glucocorticoids - administration & dosage; Graft Rejection - epidemiology; Graft Rejection - prevention & control; Graft Survival; Humans; Incidence; Kaplan-Meier Estimate; Male; Prednisone - administration & dosage; Retrospective Studies; steroid; Visual Acuity; Withholding Treatment
• ISSN: 0271-3683; 1460-2202
• DOI: 10.1080/02713683.2020.1862236

Purpose/Aims: To determine the incidence of corneal graft rejection in patients with approximately 1 year of steroid therapy following uDSEK. A shortened course of corticosteroids may be beneficial and a viable option in Ultrathin Descemet's Stripping Endothelial Keratoplasty (uDSEK). Materials and Methods: This retrospective cohort study evaluated corneal graft rejection rate in 170 cases of uDSEK that met inclusion criteria with approximately 1 year of steroid therapy. Corneal graft rejection was defined by anterior chamber cell/flare, keratic precipitates with/without corneal edema, and/or a rejection line. The following were collected retrospectively from January 1, 2005 through January 1, 2013: gender, age, race, indication for uDSEK, length of follow-up, length of steroid therapy. Continuous data were compared using Wilcoxon Rank Sum Test and categorical data were compared using Fisher's Exact Test. Results: The included eyes had an average length of steroid therapy of 431 days (range 85-720 days) with an average follow-up of 1274 days (range 395-3186 days). During the follow-up period without steroid, 5 of the 170 eyes were diagnosed with rejection (2.94%). Of the five eyes that experienced rejection, four eyes resolved after topical prednisone was reinstituted alone and did not require repeat uDSEK. The other eye was lost to follow-up. The cumulative probability of rejection after steroid cessation was calculated at 0.67% after 12 months, 2.20% after 18 months, 3.08% after 24 months, and 4.55% after 36 months. Conclusion: Discontinuation of topical steroid at approximately 1 year after uDSEK results in a low rate of corneal graft rejection and may prove extended use unnecessary.